The University of Newcastle, Australia

Beating the baby blues

Dr Nicole Reilly is investigating how pregnancy and motherhood can impact a woman’s emotional health. Her work has led to nation-wide advancement in the field of perinatal mental health, helping Australian clinicians identify at-risk mothers quickly and provide mental health support when it’s needed most.

Image of Nicole Reilly

Around one in seven women will experience perinatal anxiety or depression—that’s tens of thousands of families affected in Australia alone each year. Esteemed perinatal mental health researcher, Dr Nicole Reilly has dedicated 15 years to the pursuit of answers on behalf of these families and the health professionals who care for them, seeking to boost support for women during an often highly vulnerable time of their lives.

“My research focuses on improving our understanding of how pregnancy and parenthood can affect a woman’s emotional wellbeing, and how we can work together with clinicians and policymakers to achieve the best outcomes for women, children and families.

“A large part of this work involves investigating how we can best prevent and effectively manage depression, anxiety and psychological distress in pregnant women and new mums.”

In partnership with industry service providers, and fellow perinatal mental health research leaders, Nicole is finding ways to encourage women to speak up about their emotional wellbeing and equip clinicians to respond swiftly when needed.

“Personally, I feel very privileged that my research has been able to tell the stories and explore the journeys of women—and of health professionals—whose voices might not otherwise have been heard.”

Early intervention is key

Nicole has been at the forefront of research, policy and practice in perinatal and maternal mental health since 2007, when she worked closely with a national steering committee to co-write the beyondblue National Action Plan for Perinatal Mental Health. The Plan resulted in the $85 million National Perinatal Depression Initiative in 2008, which aimed to improve prevention and early detection of antenatal and postnatal depression and provide women with better support.

In 2018, Nicole became one of just two Australian Rotary Health postdoctoral research fellowship recipients. A significant portion of her research is focused on helping clinicians identify mental illness symptoms and risk factors during the perinatal period, a time when many women are already in regular contact with their midwife, child health nurse, GP or obstetrician. While a woman’s physical health is monitored closely during this time, her emotional health can too frequently be overlooked.

“Identifying symptoms and risk factors as a routine component of antenatal and postnatal care, and helping women access timely, appropriate support, can be so important for the wellbeing of mums, dads and babies for years to come.”

Nicole’s doctoral research, published in 2013, highlighted a lack of mental health screening for pregnant women who were receiving private sector healthcare. Her work informed the Commonwealth Government’s decision to create Medicare-funded depression screening and psychosocial assessments for women, meaning that at-risk women could be more quickly identified during routine checkups and receive timely support.

Based on her doctoral work, Nicole and her team developed innovative new services with industry partners, including ‘mummatters’, a consumer-led web-based tool for perinatal depression screening and psychosocial assessment.

“Mummatters is an Australian-only health tool. Since it was launched in November 2016, it has been downloaded and used by over 3,000 women.”

While Nicole’s work is contributing to significant progress, further research—and additional prevention and care strategies—are urgently needed in Australia.

“Unfortunately, research continues to show that there is still an enormous amount of shame and stigma that can prevent women from seeking help for their emotional health when they most need it. Yet the perinatal period is a time when the vast majority of women are in regular contact with health professionals, and it provides such a unique window to identify concerns and intervene early.”

Strategies for success

To further bolster important screening processes, Nicole is currently involved in validating a revised version of an enormously important screening tool—the Antenatal Risk Questionnaire (ANRQ), developed by UNSW’s Professor Marie-Paule Austin—which put broader psychosocial wellbeing into Australia’s national guidelines in 2017.

Nicole is also assessing a range of screening tools for anxiety, which she reveals can affect up to 15 per cent of women during pregnancy and 10 per cent of women in the year following birth.

“It is now recognised that antenatal and postnatal anxiety is as common as antenatal and postnatal depression. Australian and international clinical practice guidelines advocate for perinatal anxiety screening; however, few studies have examined the test performance of recommended screening measures using gold standard methodology. I’m working to bridge this gap in the evidence base using data from a large cohort of women in Australia.”

Two of Nicole’s current collaborative projects are Australian-first undertakings. The first will evaluate the clinical performance and cost-effectiveness of two models of integrated psychosocial assessment and depression screening in pregnant women. The other will examine healthcare professionals’ adherence to clinical practice guidelines for perinatal mental health and antenatal care.

The eagerly anticipated results are expected to inform strategies to optimise future guideline adherence, which will ultimately result in better-quality care and improved outcomes for women who give birth in Australia.

“This will, for the first time, quantify the degree to which health professionals work to best practice guidance for maternal mental health and will identify underlying factors associated with adherence and non-adherence attitudes and behaviours.”

Nicole is also interested in the intergenerational impact of maternal mental health. Together with colleagues at the Priority Research Centre for Generational Health and Ageing, she is exploring the impact of childhood trauma and adult violence on a woman’s health and parenting practices—and how it also affects their children. Research shows that, separately, a mother’s experience of adult violence and childhood trauma can be detrimental for their children. This research will take these research findings one step further.

“The project will align these fields of research by examining the potential cumulative impact of maternal exposure to adverse childhood experiences and violence across the life course on outcomes for women and their children.”

Nicole is careful to ensure that all her research projects are informed first and foremost by women’s voices, allowing real-world experiences to guide solution-focused interventions.

“During my time working in this field, so many women have given up their own time to participate in studies both large and small, and invariably say they are happy to do so if it means that the work will help other women and their families in the future. Their generosity of spirit, even in times of real adversity, are an inspiration.”

Looking to the future

In recent years, Nicole has received due attention for her research expertise, speaking at international and national conferences such as the Marcé Society for Perinatal Mental Health Conference 2019. In the same year, Nicole became one of only 15 people accepted into the inaugural International Marcé Society Mentorship Program.

“I’m honoured to be part of this program, especially as I’ve been paired with Jane Honikman, an inspirational leader and founder of Postpartum Support International, and co-founder of the Postpartum Action Institute.”

Alongside her growing research portfolio, Nicole is also heavily invested in mentoring the next generation, guiding higher degree research students in novel areas such as Indigenous perinatal health support services and the role of preconception health on mental health outcomes during pregnancy and the postpartum.

“The future of perinatal mental health research is exciting! We are starting to see real recognition now of how critical the emotional wellbeing of parents is during pregnancy and early childhood, and a more dedicated focus on the mental health and wellbeing of dads and partners.”